MANDY S MOONEYHAM, PA-C, Surgical FAYETTEVILLE, AR

Contact Information

MANDY S MOONEYHAM, PA-C

3053 N COLLEGE AVE
FAYETTEVILLE, AR 72703-3417

Phone: 479-463-2000
Fax: 479-442-4518
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Surgical	363AS0400X	97	Physician Assistant

Indicates primary specialty

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NPI Profile & details for MANDY S MOONEYHAM · (Female)

NPI #	`1831391655`
Status	Active
Credentials	PA-C (Physician Assistant-Certified)
Entity	Individual
Enumeration date	06/04/2007
Last updated	11/22/2013 - About 13 years ago
Sole proprietor ¹	No
Identifiers	AR License # P-T0716 AR License # PA-329 MO License # 2007002747 OK License # 2266 MO Medicaid 502277007 MO Other 219705 BLUE CROSS/BLUE SHIELD WA Other 0223808 DEPARTMENT OF LABOR WA
Hospital affiliation(s)	Not Available

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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MANDY S MOONEYHAM, PA-C – NPI #1831391655Surgical

Contact Information

Specialty

Surgical

NPI Profile & details for MANDY S MOONEYHAM · (Female)

Reviews for MANDY S MOONEYHAM

MANDY S MOONEYHAM, PA-C – NPI #1831391655
Surgical